AbstractBackground: Individuals with identical symptomatology may receive conflicting diagnoses, potentially leading to different treatments. The aims of this study were to assess diagnostic impressions and treatment recommendations for obsessive–compulsive disorder (OCD) versus schizophrenia-spectrum disorders (SSD).Methods: Participants (N = 82) were recruited from accredited doctoral programs. All participants were randomized to assess diagnostic impressions and treatment recommendations for 15 vignettes. These were measured across three separate testing sessions.Results: Large discrepancies in treatment recommendations were found. All participants who selected OCD recommended psychotherapy while only 15.4% of participants who identified the same vignette as schizophrenia suggested psychotherapy. More than half the participants who reported schizophrenia selected antipsychotics as the primary response; medication was not a primary recommendation when the vignette was identified as OCD.Conclusion: Symptoms conceptualized as SSDs were recommended medication; those same symptoms conceptualized as OCD were recommended psychotherapy. Greater awareness regarding the efficacy of psychosocial treatments for SSDs is needed.